One Lung Ventilation

[VentdependenT]

Low tidal volume higher respiratory rate (via ARDS style protocol) or the old standard?

What do you guys think? Is there a meaningful difference? Can you prevent ALI by using the low tidal volumes?

 

[Noyac]

Low tidal volume higher respiratory rate (via ARDS style protocol) or the old standard?

What do you guys think? Is there a meaningful difference? Can you prevent ALI by using the low tidal volumes?

You know, I do both still. It depends on the pt, the PIP, the surgeon, the sats, etc. If someone can show me were one is better for all, then I'll change.

 

[Planktonmd]

You know, I do both still. It depends on the pt, the PIP, the surgeon, the sats, etc. If someone can show me were one is better for all, then I'll change.

Yes, each case is different.
Most of the times I just decrease the TV slightly and increase the rate a little and see what happens to the PIP, and SPO2.

 

[urgewrx]

For lung transplants, the surgeon and pumonologist really insist on it. I don't know if there is transplant data or they are just extrapolating ARDS data.
For the run of the mill 1-3hr thoracic case there might not be any difference, or at least very hard to show on clinical trial. I use the lowest volume my ETCo2 allows.
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[VolatileAgent]

just remember, plateau pressure is the most important number - not PIP.

 

[VentdependenT]

just remember, plateau pressure is the most important number - not PIP.

unless there's a big goober in the ett, bronchospasm, pt chompin on the tube etc...😀

 

[militarymd]

Low tidal volume higher respiratory rate (via ARDS style protocol) or the old standard?

What do you guys think? Is there a meaningful difference? Can you prevent ALI by using the low tidal volumes?

I would go with low TV in pneumonectomies...just because the risk of ARDS (or post-pneumonectomy pulmonary edema for the old schools folks) is relatively high.

otherwise...no difference.

 

[VolatileAgent]

unless there's a big goober in the ett, bronchospasm, pt chompin on the tube etc...😀

yeah, you're right. assuming there's no other obstruction downstream from it, the point of maximum obstruction is the elbow joint at the tip of the tube. that's what the ventilator is measuring as the "peak" pressure when the bellows/pistons starts-a-pushin'. of course, in your scenario the mean airway pressure would also be way outta whack.